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Turkmenistan: Grim Hospitals Making Babies Sick

Women are giving birth in unhygienic, poorly staffed maternity clinics.
By IWPR staff
When Nyazik was in hospital after giving birth she was shocked by what she saw. Mousetraps lined the ward and cockroaches ran across her bedside table, keeping her awake at night for fear they would crawl into her bed.



“In the morning a cleaner came and collected the mice from the mousetraps, cleaning the floor with a rag soaked in water with chlorine. With this rag she wiped the window frames and bedside tables,” she said.



This is by no means an unusual story in modern Turkmenistan. Terrible sanitary conditions and a lack of specialist doctors have made it dangerous to give birth at clinics and maternity hospitals. Most date from the Soviet era and have not had major repairs since they were built.



Even worse, medicine has been self-funding since 2003, meaning doctors must pay for the upkeep of their own facilities.



“At maternity wards, cleaners buy bleach and disinfectant at their own expense. Nurses and obstetricians are forced to buy gloves, gauze and spirit. In this situation, observing sterility and hygiene is out of the question,” said an obstetrician at an Ashgabat maternity hospital.



Women often refuse to give birth at state maternity hospitals, because of the frequent infection of newborn children with diseases like meningitis, hepatitis B and C and salmonella.



A doctor in the maternity department of the National Research Institute for the Health of Mother and Child explains that medical staff can frequently diagnose a sick baby simply by knowing where they were born.



“For example, if a child was born in the city railway hospital, then it probably has meningitis. Hepatitis cases come from maternity hospital number one, while children born in our institute catch salmonella,” said the doctor.



However, problems do not stop at the level of hygiene. In summer 2005 a brand new maternity hospital was opened in Ashgabat equipped with the newest medical equipment, individual wards for each mother and child and tiled with marble. But the hospital lacks specialist doctors, a situation that is made worse by unorthodox selection procedures.



“Everyone lined up in the yard and those who could expect a job at the new clinic were pointed to. Selection was conducted according to height, build and appearance. As we were told afterwards, only young, strong, healthy specialists should work in the new clinics of the Golden Age,” said a doctor at Ashgabat’s clinic number nine.



The fact that the Turkmen State Medical Institute stopped training specialist doctors in 2002 has long ceased to be a secret. The country’s health service has been in decline since independence and the number of medical students is a quarter of what it once was. Now the state only trains family doctors, whom it believes should be able to carry out a wide range of specialist activities, according to a lecturer at the Institute’s histology department.



Owing to the lack of specialist doctors at maternity hospitals, a mother-to-be is dispatched to the operating theatre at the smallest sign of a complication.



“It is now common to give caesareans, even if there’s no medical reason for doing so. Women are virtually forced to have an operation so that they give birth during working hours. This is done because doctors do not wish to be kept at work, and they don’t want to be summoned from home in the middle of the night,” said one maternity nurse.



Most women are initially against surgical procedures. Merjen explained that she had to pay doctors to let her give birth naturally – a scenario common at many of the country’s maternity hospitals.



“I gave birth two months ago and should have had a normal delivery. But the doctor wanted me to have a caesarean to avoid any risk. I had to agree on a separate fee with him so that I could have a normal birth. In the end, I gave birth to a healthy child without complications.”



The alternative is to give birth at home. This choice is being made not just by women in poor rural areas, but also by well-informed, educated ones who know all the risks and possible problems of home births.



Makhri, head of the licensing department at the communications ministry, has twice given birth at home without any complications.



“Doctors were convinced that I would need an operation. I was categorically opposed to this and decided that I would give birth at home. I now have two healthy children, and I don’t regret what I did at all,” she said.



But the authorities are opposed to this sort of arrangement. Recently, a family doctor from one Ashgabat clinic was rebuked when a child in her district was born at home.



“We received a house call for a nine-month-old baby, who had a high temperature and was wheezing. It turned out that the child had no documents, because it had been born at home. Three months later and I’m still having to explain how this could happen in my district,” he said.

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